Trends in Health Care Commissioning
نویسندگان
چکیده
In recent years there have been marked changes in organisational structures and budgetary arrangements in the English NHS, potentially altering the relationships between purchasers (primary care organisations (PCOs) and general practices) and providers. Using data on elective hospital admissions from 1997/98 to 2002/03 we find that commissioning has become significantly more concentrated at PCO and GP level. There was a reduction in the average number of different providers used by PCOs (16.7 to 14.2), an increase in the average share of admissions accounted for by the main provider (49% to 69%), and an increase in the average Herfindahl index (0.35 to 0.55). About half the increase in concentration arose from the increase in the number of purchasing organisations from 100 to 302. The rest was due to mergers amongst providers and the abolition of fundholding. GP fundholding practices which held budgets for elective admissions had less concentrated admission patterns than non-fundholders whose admissions were paid for by their primary care organisation. There was an increase in concentration of admissions for both types of GP practice but fundholders used more providers, had smaller shares at their main provider, and had smaller Herfindahl indices.
منابع مشابه
Historical review of the commissioning of health care disciplines in the USPHS.
PURPOSE The purpose of this investigation was to examine the commissioning history of the professions of physicians, dentists, nurses, nurse practitioners, physician assistants and dental hygienists of the United States Public Health Service (USPHS), and to determine a critical pathway to commissioning new health care professions into the USPHS. The Advanced Dental Hygiene Practitioner (ADHP), ...
متن کاملPrimary care-led commissioning and public involvement in the English National Health Service. Lessons from the past.
BACKGROUND Patient and Public involvement (PPI) in health care occupies a central place in Western democracies. In England, this theme has been continuously prominent since the introduction of market reforms in the early 1990s. The health care reforms implemented by the current Coalition Government are making primary care practitioners the main commissioners of health care services in the Natio...
متن کاملHealth Services Management Centre Health Care Commissioning in the International Context: Lessons from Experience and Evidence
If you are reading this document, it is likely to be because you have an interest in how we can improve health care commissioning in the NHS and an appetite to use international comparisons to help us to do so. Our rationale for asking Chris Ham to produce this high level paper was based on a conviction that management decision making should be as much as is practicable evidence based (acknowle...
متن کاملCommissioning care for people with dementia at the end of life: a mixed-methods study
OBJECTIVES To understand how end-of-life (EoL) care for people with dementia is currently commissioned (ie, contracted) and organised, with a view to informing the development of commissioning guidance for good-quality community-based EoL care in dementia. DESIGN Mixed-methods study; narrative review and qualitative interviews. SETTING 8 National Health Service (NHS) clinical commissioning ...
متن کاملEffective Commissioning of Sexual Health and HIV Services A Sexual Health and HIV Commissioning Toolkit for Primary Care Trusts and Local Authorities
متن کامل
Practice-based commissioning and sexual reproductive health services: opportunities and threats.
J Fam Plann Reprod Health Care 2006: 32(1) Background The National Health Service (NHS) in England is going through another reorganisation, in the spirit of creating a ‘patient-led NHS’. Practice-based commissioning (PBC) refers to devolution of commissioning responsibilities from primary care trusts (PCTs) to individual or groups of primary care professionals; this may be a group of general pr...
متن کامل